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HARRISBURG — Gov. Tom Corbett turned down an expansion of Medicaid under President Obama's health care overhaul because it would cost the state $4 billion during the next eight years and result in “a large tax increase” for Pennsylvanians, his office said on Wednesday.

“The bottom line is that, despite whatever funds come in from Washington, Medicaid expansion is not a free deal for Pennsylvania state taxpayers,” Corbett spokeswoman Christine Cronkright said. “The premise that the federal government is picking up 100 percent of the costs of expansion is simply inaccurate.”

Critics, including Democratic leaders in the state House and Senate, claim Corbett is giving up $4 billion a year that the state could receive by expanding Medicaid.

“We'd gain $43 billion in federal dollars over 10 years,” said Rep. Joe Markosek of Monroeville, ranking Democrat on the House Appropriations Committee. “There's a huge economic boost to the state that will be lost. There is also a huge human cost if we do not (expand).”

Cronkright disputed that, saying the government would provide the state $1.5 billion the first year and up to $3.5 billion in the fourth year. That money comes with “strings attached,” she said, and Corbett wants flexibility in spending it and the right to change course.

Nineteen states have tentatively decided to expand Medicaid enrollment. Eleven states have said no. Others are undecided. Some states that indicated they will enroll require legislative approval, said Melissa Hansen, an analyst with the National Conference of State Legislatures.

Corbett told lawmakers in his budget address Tuesday that he would not accept the deal promising billions in federal money to expand Medicaid unless the government changes its rules and allows states more flexibility. An expansion would require $221 million in the 2013-14 spending plan.

Pennsylvania law does not require legislative approval of an expansion, legislative staffers said.

In a letter to the Department of Health and Human Services, Corbett warned that “without reform, the only way to support these costs would be a large tax increase on Pennsylvania families.”

Pennsylvania provides Medicaid — health insurance for low-income people — to more than 2.2 million adults and children. Nationally, Medicaid covers about 60 million people. The state spends $22.6 billion in state and federal money on Medicaid, accounting for about 75 percent of the Pennsylvania Department of Public Welfare's budget.

The health care law Congress approved in 2010 required the expansion. Corbett, a former prosecutor, was among attorneys general who sought to overturn the law. In its June review of the law, the U.S. Supreme Court made Medicaid expansion optional for states.

Obamacare would add up to 800,000 Pennsylvanians to Medicaid, Cronkright said. Other estimates range from 500,000 to 600,000.

“This expansion would cover vulnerable persons, as well as healthy, able-bodied individuals,” according to a Welfare Department “fact sheet” Cronkright provided.

Under the Affordable Care Act, or Obamacare, a family of four could make up to $30,000 a year and receive Medicaid coverage, Cronkright said.

House Minority Leader Frank Dermody, D-Oakmont, said the Medicaid dollars Pennsylvania declines will provide health care for people in other states.

But, Cronkright said: “Any money from the federal government is temporary funding for a permanent obligation on behalf of the state. This decision is not about the benefits for one to three years; it's about the long-term costs.”

Brad Bumsted is state Capitol reporter for Trib Total Media. He can be reached at 717-787-1405 or bbumsted@tribweb.com.

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